Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Molina Healthcare before sending sensitive documents. FaxFlow is not affiliated with this organization.
Molina Healthcare fax number
(562) 499-0610
Grievance and Appeals
Used for: Submit standard Medicare/Part D appeals and medical coverage decisions via fax to Attn: Grievance and Appeals; Fax: (562) 499-0610. Mailing options also available as noted in provider manuals.
Fax destination details
- Department
- Grievance and Appeals
- Purpose
- Submit standard Medicare/Part D appeals and medical coverage decisions via fax to Attn: Grievance and Appeals; Fax: (562) 499-0610. Mailing options also available as noted in provider manuals.
- Form
- Disenrollment Notice / Enrollment Cancellation Form — Enrollment Cancellation/Disenrollment Notice
- Address
- PO Box 22816, Long Beach, CA 90801-9977
- Voice phone
- 562-499-6191
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Fax a signed written notice to Molina Medicare at the fax number (562) 495-1726. Include member information and the reason for cancellation or disenrollment; follow Molina's enrollment cancellation process as described in the Molina Medicare Producer Guide.
Sources and verification
FaxFlow records the public sources found during directory research. A source link is useful evidence, but it is not a guarantee that a number still reaches the same team.
No public source link was saved with this record. Confirm the number directly with the organization before using it.